RSNA exhibitors give star billing to CT

The 2004 RSNA meeting was the first in years that held something for everyone in every modality and every product class.

Integration and 3D were woven into imaging IT, as vendors positioned their radiology information system/PACS as seamless sets, able to snatch and display information effortlessly from any point in the healthcare stream and in any manner desired. Mega-slice CT and high-performance MR powered the move toward volumetric presentation.

Digital x-ray matured with new and improved models bent on practicality. Computer-aided detection took root outside mammography with offerings in virtual colonography, breast MR, and lung CT.

Ultrasound shone with new twists on old ideas. Real-time 3D addressed real-world problems in productivity and clinical need. Software architectures blazed new technological paths.

The linchpin to it all was IT, which allows the transfer of images among "ologies." But vendors mainly emphasized integration at the RSNA meeting, held in Chicago in December. They have leveraged standards-based interfaces and the Integrating the Healthcare Enterprise framework to combine the RIS and PACS components and to make these systems work with other technologies. They have also harnessed the network backbone to support advanced tools for nuclear medicine, orthopedic templating, and 3D imaging.

TeraRecon made its AquariusNET 1.5 compatible with RIS/PACS to support distributed, user-friendly 3D applications. Agfa, Amicas, Sectra, Delft Diagnostic Imaging, and Intelerad Medical Systems took advantage of the technology. They integrated the server dedicated to postprocessing with their own PACS on the RSNA exhibit floor to achieve real-time 3D, maximum intensity projection, and multiplanar reconstruction tools.

It has been a while since practitioners and vendors paid much attention to open MR. But several novel products exhibited at the RSNA meeting changed that. Philips' Panorama 1.0T arrived in Chicago not as a work-in-progress, as it had every year since 1999, but as a commercial product. The company plans to begin routine deliveries early this year of the open system, which it says provides image quality and throughput comparable to 1.5T units.

The most novel idea, however, came from Esaote. This member of the Bracco family of companies, best known for making extremity scanners, unveiled its G Scan, a compact open MR that can image the spine while a patient is lying down or standing up. The table and magnets rotate from a horizontal to a vertical position.

The drum beat for the next generation of CT scanners began the moment visitors set foot on the exhibit floor. Siemens, GE, Philips, and Toshiba are either shipping 64-slice scanners or plan to begin next year. Field upgradability could prove critical in the months ahead as buyers of Toshiba's 32-slice and Philips' 40-slice scanners, both in production and offered as lower priced alternatives, want to step to the head of the class. The transition for Aquilion 32 owners will be a snap, said Doug Ryan, director of Toshiba's CT business unit.

GE and Siemens took the high ground in PET/CT, demonstrating 64-slice versions of their hybrid scanners. GE's Discovery VCT may not appear, however, for another 12 to 18 months. Siemens' souped-up biograph is scheduled for delivery in mid-2005. Both systems are intended for cardiac applications, the logical next step for PET/CT, which today is being driven mostly by oncologic applications.

"The true 3D nature of the data sets, the high-resolution PET data set (of the heart) combined with the high-resolution coronary CTA, will allow the user to come up with a one-stop cardiac assessment," said Markus B. Lusser, vice president of worldwide sales and marketing for Siemens nuclear medicine division.

The developers of multislice SPECT/CTs hope their new products will do for gamma cameras what hybrid imaging has already done for PET. In their first appearance at the RSNA meeting, Siemens' TruePoint Symbia and Philips' Precedence attracted large crowds and raised questions about which hybrid modality-SPECT/CT or PET/CT-would win the "hearts" of physicians.

"The opportunity to overlay the coronary artery tree on SPECT will be very appealing, but SPECT is not that effective in viability assessment. So initially, I think SPECT/CT will be used, but then PET/CT will become complementary with respect to viability," said Ian Farmer, senior vice president and general manger of Philips Nuclear Medicine.

Siemens Medical Solutions unveiled its full-field digital mammography system, the Mammomat Novation. Others are on the way, including products from Planmed and Giotto, both of which showed their systems as works-in-progress.

On the radiography side, both cost-effectiveness and mobility made inroads. Siemens led the way, introducing the Mobilett XP Digital, a mobile digital x-ray system built around a flat-panel detector. The product provides instant image display that should enhance both productivity and workflow, the company said.

Orex introduced the Orex ZR, a CR system on wheels. The cordless, wireless unit can move freely within a medical facility without external power or network connections.

The trend in cardiovascular x-ray is toward increasingly higher resolution and improved workflow. To that end, Philips showcased its Allura Xper FD20, a flat-detector interventional system that provides up to four times the resolution of conventional angiography systems.

Toshiba America Medical Systems introduced the Infinix VC-I 3D. Features include dual PC processors, a digital network communication platform, a high-performance x-ray intensifier, CCD camera, and dose control options.

GE Healthcare framed 4D ultrasound as the way to accelerate workflow, using protocols developed for the company's new version of its Logiq 9. The scanner, outfitted with 4D algorithms and three volumetric probes, debuted at the GE booth.

"By taking the acquired data and transmitting it to the workstation, we can essentially rescan the patient to regenerate any plane that may or may not have been seen earlier," said Omar Ishrak, president and CEO of GE's diagnostic ultrasound. "We think we can change the workflow in ultrasound by scanning patients, letting them go, and then rescanning on the workstation rather than on the patient."

Among other products featuring 3D was Medison's Accuvix 3DXI release, which offers depth perspective, step-through anatomy, image rotation through any view, and depictions of scan plane relationships.

Esaote exhibited technology that makes ultrasound data multimodal, correlating and overlapping CT and MR images derived from volumetric data onto sonographic scans to localize lesions for ultrasound-guided interventions.

Computer-aided detection tools for breast imaging are focusing on the speed and efficiency of reviewing mammography films, as well as MR and ultrasound scans.

Cedara Software is developing B-CAD for breast ultrasound to identify, annotate, and quickly classify suspicious lesions on the basis of a biopsy-correlated database of sonographic characteristics.

The ImageChecker DMax CAD system shown by R2 Technology promises to double throughput of mammographic cases without sacrificing image quality. Built around a 50-micron-resolution laser film digitizer from Array, it is capable of scanning one film every 30 seconds, according to the company.

In addition to the CADstream image analysis system for breast MR, Confirma displayed its multichannel, phased-array Access Breast Coil, designed for improving workflow with its unilateral and bilateral parallel imaging of the breast, axillary tissue, and chest wall.

RSNA attendance edges up

RSNA meeting attendance reached levels similar to those prior to the terrorist attacks of Sept. 11, 2001. A preliminary account of total attendance pegged the number at 59,895, the highest since 2000 when 59,794 people attended the event. Compared with 2003, professional registration increased 4% to 26,401, but guest registration was down 2% to 5772, reflecting travel costs and visa restrictions. Vendor attendance showed signs of a gradual recovery, climbing 0.6% to 27,722, but was still below the levels of 2000 and 20